Lithium Reduces Risk of Suicide in Patients With Mood Disorders

Lithium can cause side effect and toxicity burden and should be monitored.
Lithium can cause side effect and toxicity burden and should be monitored.
Lithium is the only medication to demonstrate an antisuicidal effect over and above its action on mood episodes in bipolar disorder.

According to a recent meta-review published in Bipolar Disorders, lithium reduces the risk of suicide among patients with mood disorders.

Researchers from the department of psychiatry at the University of Oxford, Warneford Hospital, in the United Kingdom, conducted a literature review and selected meta-analyses and systematic reviews that analyzed the association of lithium with suicide and self-harm. Of the 16 systematic reviews found, the investigators selected 4 (3 on lithium and suicide; 1 on lithium and self-harm) for analysis based on their inclusion of only randomized controlled trials.

In the 3 studies that evaluated the effect of lithium on suicide, 2 studies published by the same group reached the conclusion that lithium reduced the rate of suicide compared with other compounds and placebo. Overall, lithium was found to reduce the risk of suicide by more than 60% compared with placebo.

The study authors noted that the third systematic review that evaluated lithium and its association with suicide reached the conclusion that lithium did not have a significant effect on suicide rates; however, the study authors attributed this lack of effect to the inclusion of a methodologically flawed paper, which reported no suicidal events in either the lithium or placebo groups.

A Cochrane review found that lithium may reduce self-harm compared with other agents and placebo.

Although the researchers attempted to determine the effect of lithium on suicidal ideation, they noted that studies focused on this outcome were scarce.

“The combination of evidence from randomised and observational data agrees and is overwhelmingly in favour of the anti-suicidal action of lithium,” Dr Katharine Smith, honorary consultant psychiatrist at the NIHR Oxford Cognitive Health Research Facility and co-author on the study, concluded. “Lithium is the only medication in bipolar disorder thus far to have shown a specific anti-suicidal effect over and above its action on mood episodes.”

Related Articles


Smith KA, Cipriani A. Lithium and suicide in mood disorders: updated meta-review of the scientific literature [published online September 12, 2017]. Bipolar Disord. doi: 10.1111/bdi.12543